Healthcare Provider Details

I. General information

NPI: 1841713435
Provider Name (Legal Business Name): COLE ANTHONY STAINES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N WATER ST
SILVERTON OR
97381-1625
US

IV. Provider business mailing address

411 N WATER ST
SILVERTON OR
97381-1625
US

V. Phone/Fax

Practice location:
  • Phone: 503-567-5170
  • Fax:
Mailing address:
  • Phone: 503-567-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD12330
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: